20 December 2010

This year has been a weird one for me and cancer. In the ER, we see cancer patients pretty infrequently. The occasional chemotherapy with fever, but that's about it. I think the oncologists try hard to keep the patients out of the ER -- to everybody's benefit. But this year, I've had a weird rash of cases where I've made primary diagnoses of cancer in the ER -- several times over and over and over again. In ten years I don't think I've made as many cancer diagnoses as I have this year alone. Just very strange.

Unfortunately, it came home to roost. My wife was diagnosed with breast cancer last week.

This is an unusual case, in that my wife is quite young, and that the cancer was diagnosed shortly after our fourth child was born. Likely the pregnancy/nursing changes in the breast masked the lump; when she first noticed it, she thought it was perhaps a clogged milk duct. She showed it to her OB, who recommended watching it for a couple of months. When it did not go away, the OB ordered an ultrasound and mammogram (and thank the FSM that she was so meticulous), which showed a pretty obvious, relatively large cancer.

So it's moderately aggressive and locally advanced infiltrating ductal carcinoma. We are expecting it to be Stage 2b or 3, depending on the number of lymph nodes involved (they are palpable and appear enlarged on US). Curiously, the one node they biopsied was clean, so we are holding out hopes they might not be involved. Most importantly, the receptor status is encouraging: ER/PR negative (as one would expect in such a young woman) but HER2 positive. This is good because it opens up some treatment options, notably Herceptin, and avoids the poor prognosis involved in what they call "triple negative" breast tumors.

Having said that, this is going to be a rough road for our family. We anticipate, after staging is complete, a mastectomy followed by chemo and radiation. The chemo will be adriamycin and cytoxan, which I understand to be pretty brutal, for 12 weeks, followed by Herceptin and Taxol for another 12 weeks or so. Having said that, with what we know right now, we believe that there is good reason to expect a cure.

Obviously, this has been a pretty huge shock to our system. It's scary and maddening. We've been shuttling back and forth to tests and doctors' appointments all week. We have also been suffering from emotional whiplash as we veer from despair to determination and back again. But so far we are holding it together very well. The kids took the news well and seemed to process it at an age-appropriate level. We have been overwhelmed by the outpouring of support from our friends and family. Absolutely everybody seems to want to do something to help. It's humbling, since my wife and I are the sort of people with a mortal dread of imposing on others, but the reality is that we are going to need it. I'll be pretty focused on taking care of my wife, and I'll have to go back to work, and the kids are going to need to get to school, laundry, dinner and the usual stuff will need to be done. So we are going to have to learn to graciously accept some help; the biggest challenge will be coordinating all the volunteers to match our needs.

It could go without saying that blogging will be light to irregular as my priorities have been completely turned upside down. Don't list me as a dead blog -- I hope to come back to my regular, industrial-strength blogging once the treatment is complete, which is probably six months or so.

For those who wish to follow her progress and know what's going on, we have created a journal at the Caringbridge website which you can read. A lot of our friends -- both real and online -- have asked what they can do to help. We thank you for all your support and warm thoughts. We don't really have a lot of needs beyond those which are local, but we would love to have your notes of support and encouragement for Liza over at Caringbridge. For those who wish to do something more tangible, I would encourage you to donate to a cancer charity. Longtime readers will know that my charity of choice is St Baldrick's Foundation, which raises money for pediatric cancer research, and I do intend to shave again this year. So if you feel the urge to take action, you can click here and donate to St Baldrick's online. And if you have breasts, or know someone who does, remind them to take a moment and do a breast self exam.

I hope all comes out as well as it can from her further tests. I'll keep you in my heart and thoughts. As a young medical professional, this reminds me to always be meticulous and always encourage my patients to be the same.

I have followed your blog for some time..my heart goes out to your wife, and your family. I am a cancer survivor, I recieved CHOP with radiation so I realize what she and you as well, will be going through. I will keep all of you in my prayers, thoughts and heart.

Well, that sucks. Having been through something similar, I'd like to suggest that you ask people for frozen meals, either homemade or from somewhere like Dream Dinners. You're going to want a semblance of normality as you go through month after month of this crap, and you can't get takeout every night. And that way when people ask what they can do, you have an easy answer for something that's not too big a favor and would really help your family.

I'm sorry to hear this. My husband spent last fall and winter being treated for cancer (with a good outcome), and so I have some small idea of what you're currently going through. I'll keep your family in my thoughts.

I have read your blog for many years. I am not in the medical field at all... just a computer nerd in Seattle. I am very sorry to hear the news. I can't imagine the shock after just having your fourth baby. Take care of you and your family.

I too have read for years and don't think I ever commented. I do feel for you both as the cancer diagnosis of my partner two years ago was the single most disruptive and upsetting event of my life. I will keep an eye on Caringbridge.

People are yearning to contribute when they hear about a friend going through something like this. Allowing them to help out with meals etc is doing them a favor. It is very frustrating to stand on the sidelines unable to help.

So you are not imposing by accepting help. You are really doing your friends a favor by making them feel less frustrated by the whole thing.

You are in a community with access to the best care. The FSM will wrap his noodley appendages around your family and keep you all safe.

Recently I wrote another one of the cycle of poems I began after a gifted surgeon barely saved my life, from a bowel blocked with cancer. My friends, knowing I'm a published author, were asking 'Beryl, are you going to write a book about this'. I won't take you through the whole process I followed. Enough to say I now have 2 books 'Cancer - a Journey' and 'After Cancer - the Journey Continues' which people tell me help them a lot - written by someone who knows what it's like.I've recently been interviewed for radio more than a dozen times into teh US by phone from Australia. In March I'm presenting 2x 75 min workshops for the '12th Annual International Summit on Improving Patient Care in the Office Practice and the Community' for IHI (Institute for Healthcare Improvement)and veery glad to have the chance to help doctors understand more about the best way to communicate with their patients.I'm moved by your account of diagnosing cancer in the ER. That tells me those people were in the same position as I was; I'd been trying for 18 months for a diagnosis.Now your wife is struck down - and you have young children. One of the bright spots in the last 9 years for me is that my 5 children are grown; I recognise that as the bonus it is. I still wanted to stay alive for them and for my 7 grandchildren. Now I get out of bed every morning because I'm helping others along this terrible journey.I wish you the strength to take your lives moment by moment. If you identify any way I can help you and your family please let me know. Have a look at my blog http://courageandcancer.blogspot.comThe latest entry has 6 'life poems' to help people like you and your dear wife who are having to cope with everyone around you celebrating, when you probably feel anything but---.Blessingsberylshaw@netspace.net.au

"Cancer Sucks"...you got that right. My husband is a 5-year survivor of peritoneal mesothelioma and I was diagnosed and treated for Stage 1 breast cancer this year. We're not even out of our 40s! Then my sister in law was diagnosed with Stage 2b breast cancer HER2 positive and undergoing chemo at the present time. Still life is good. Keep hope and faith. Five years ago, I thought I'd be a widow and my children would grow up without their father. He's still here and still going strong. There is much to be gained along the journey. Hug your kids and each other a little more. Best wishes to you and your wife as she goes through treatment. I look forward to a future post that she has completed treatment and is cancer free.

Oh please, ask for help. Driving, laundry, food - ask for help. When my husband was down and people would ask what can I do, I would say bring food. And they did. People really do want to help, give them an assignment, they'll be there. Get someone to set up a schedule so you're not bombarded with casseroles at the get go. This is a project, you need a project manager. Delegate. God be with you all.

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I am so sorry! No one ever expects cancer to be so close to them, I know I sure didn't when I was diagnosed shortly after my 4th baby was born. I am thinking good thoughts for your family and if there is anything I can do to help please let me know. I know you don't know me, but I read here all the time and would help in any way I can.

Another longtime, non-commenting lurker here. Very sorry to read about your wife's diagnosis. I was also diagnosed with BC at a relatively young age, and was also HER2+. Three cheers for the miracle drug of Herceptin!! I also had the AC chemo combo and then taxol with Herceptin, but then continued with Herceptin for another year after chemo. I was suprised to read that your wife will only do Herceptin for 12 weeks. But I DO NOT mean to question anyone's medical treatment here or the plans you have dicussed with her medical team. And I know that treatment plans can change over time as well.

But mostly I want to convey that I think your wife is lucky to have such a supportive husband with her as she (and your family) endures this hard road. Chemo sucks beyond belief and I was so fortunate to have my good-natured and humourous husband by my side to keep my spirits up. So take care of yourself too, Shadowfax!!

Correction to my post above...I just read your CB site and I see she is doing Herceptin for several months following the conclusion of Taxol. I had wondered if the protocol changed or something; now I see that it has not.

Such a bummer, but I am thankful you shared the news about your beloved Liza. Tell us how to send messages to her on Caring Bridge - those encouraging notes will make a huge difference in the days to come.

Someone advised me - when going through tough time - best thing is to keep everything in your life as simple as possible. I did everything I could to make everything in my life as simple as I could - from meals to commuting etc. It helped alot.

I've been reading your blog so long, you just feel like a friend, of sorts. I'm glad you've shared this and I will be sending out good stuff to the universe/He Who is Large and in Charge/etc for Liza and you all.

I am glad you are having Chirtmas now - maybe a boss t of sorts before all the treatment starts -

Cancer does suck. I've been reading your blog for the past year, and I never comment... until now. I'm not someone who prays, but I will keep your wife and family in my thoughts with best wishes and hopes for a speedy and uncomplicated full recovery.

You said it right when you said that cancer sucks. I take it by now that you know for sure the stage and grade of the cancer and are well on your way into treatment. I pray for the best for your wife. On April 14, 2004 I was diagnosed with Stage 3 grade three, er/pr-, strongly Her/2 positive multifocal invasive ductal carcinoma. Seven out of nine axillary nodes were positive after dose dense, neo-adjunct chemotherapy, one grossely positive. I hope that I'm still here to write this to you will give you and your wife some comfort. This can be overcome. You are right to accept any and all offers for help. If they are vague, "Let me know if there is anything I can do?" should be met with, "Actually, if you could pick Jr. up from soccer on Mondays" is acceptable. You and your family will be in my prayers.

Shadowfax, I was really sorry to hear about your ordeal with breast cancer. But I do have to say your commend near the end “and if you have breasts, or know someone who does, remind them to take a moment and do a breast self exam” may have saved my life. I did an exam right after I read your blog, found a lump and have been a path since that may prevent me from developing breast cancer. So I have to thank you and repeated your quote in my blog in hopes that more women and their families will be spared this diagnosis. So thank you so very much for thinking about others even when you are struggling. Cancer does suck!

Shadowfax, I am sorry to hear about your wife's condition. I know she will get through this with your help and your love. I have been following the blog of a relative of my wife, a Pediatrician whose wife has been beating back pancreatic cancer successfully, and have to say that this outlet (blogging) seems to have been as inspiring for his readers as it has for his family. Perhaps you will do us the favor of letting us know how Liza is doing from time to time. Your insights would undoubtedly help all of us cope with the next roadblock in our own lives.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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